Family Med Medical News about acute asthma exacerbations; pediatric patients; dexamethasone; prednisone

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Use of dexamethasone and prednisone in acute asthma exacerbations in pediatric patients
Canadian Family Physician, 07/15/09

Shefrin AE et al. - Short courses of systemic corticosteroids are indicated in the treatment of moderate and severe asthma exacerbations as well as mild exacerbations unresponsive to increased doses of beta-agonist therapy and inhaled corticosteroids. Prednisone (1 to 2 mg/kg daily for 5 days) and dexamethasone (0.3 to 0.6 mg/kg daily for 1 to 5 days) are appropriate choices, with some evidence suggesting that dexamethasone might be better tolerated and requires shorter duration of therapy. Side effects of short corticosteroid treatments appear minimal and clinically insignificant. More studies are needed to ascertain the optimal dose, duration, and choice of systemic steroids, especially in the ambulatory care setting.

Exclusive Author Commentary
Allan E. Shefrin, 07/16/09

It is clear to us that systemic corticosteroids are beneficial and safe in the treatment of moderate to severe asthma exacerbations in children who present to emergency departments. What remains to be seen (or studied) is whether such a benefit is seen when used for milder exacerbations or in the community office setting. We look forward to seeing more work done in this area.

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